As public-health officials confront the largest outbreak in the U.S. in decades, they’ve been fighting as much against dangerous ideas as they have against the disease.
By Nick Paumgarten
August 26, 2019
“People seem to think measles is some happy Norman Rockwell rite of passage,” New York’s health commissioner said.
One day in the early sixties, Saul Zucker, a pediatrician and anesthesiologist in the Bronx, was treating the child of a New York assemblyman named Alexander Chananau. Amid the stethoscoping and reflex-hammering of a routine checkup, the two men got to talking about polio, which was still a threat to the nation’s youth, in spite of the discovery, the previous decade, of a vaccine. At the time, some states had laws requiring the vaccination of schoolchildren, but New York was not one of them. In his office, on the Grand Concourse, Zucker urged Chananau to push such a law, and shortly afterward the assemblyman introduced a bill in the legislature. The proposal encountered resistance, especially from Christian Scientists, whose faith teaches that disease is a state of mind. (The city’s health commissioner opposed the bill as well, writing to Chananau, “We do not like to legislate the things which can be obtained without legislation.”) To mollify the dissenters, Chananau and others added a religious exemption; you could forgo vaccination if it violated the principles of your faith. In 1966, the bill passed, 150–2, making New York the first state to have a vaccination law with a religious exemption. By the beginning of this year, forty-six other states had a version of such a provision; it has proved to be an exploitable lever for people who, for reasons that typically have nothing to do with religion, are opposed to vaccination. They are widely, and disdainfully, known as anti-vaxxers... (continues)
Friday, August 30, 2019
Friday, August 16, 2019
Proactive probiotics
"You should start taking probiotics now, before we discover that they don't make a difference."
NYker
Monday, August 12, 2019
Should Patients Be Allowed to Choose — or Refuse — Doctors by Race or Gender?
By Kwame Anthony Appiah
Aug. 6, 2019
I work for a public medical system, and we have an ethics seminar each month. The last one featured an article by a doctor in one of our hospitals. She discussed patients or their families who insist on having medical providers who are some combination of straight, white, male and/or American-born.
Some seminar participants thought patients should be able to choose such a provider in our system because they can do so in the private care system and because we now encourage them to use the private system if they prefer.
I was shocked that any providers considered it ethical to support patients’ openly making health care decisions based on bias. The point was also made that treatment is often provided in emergency settings where a patient’s life is at stake. Many of our treatment options are aimed at small populations of patients, so there may be only one practitioner available. That practitioner may not be male, straight, white or American-born. Patients cannot receive some types of specialty care outside our system, so they do not have the option of shopping around for all types of medical care. Is it truly ethical for patients to demand that their bigotry dictate who treats them? Name Withheld
Is it ethical for patients to want their bigotry to be accommodated? That’s an easy question: no, because expressing bigotry isn’t ethical. The harder question is whether health care professionals ought to accommodate their bigotry.
Everyone knows that doctors must not discriminate on the basis of gender, sexuality, race, religion or national origin when they select or treat patients: It’s an obligation they accepted when they entered the health care profession. (That doesn’t mean they have to take all comers; they can turn away patients for various other reasons.) But should patients be able to choose clinicians on the basis of such attributes? The answer is: It depends.
In an outpatient setting — in private care, as you note — patients can freely discriminate in choosing whom they want to treat them. That may be unethical as a matter of personal conduct, but we don’t want a system that would try to sift through their motives and correct for invidious ones. We’re in the Zocdoc era — something like Tinder M.D. Patient-consumers, in this context, have the prerogatives enjoyed by suitors to make choices that are biased and boneheaded.
The picture changes when we’re in an institutional setting, one in which patients haven’t chosen their health care practitioner. The picture changes when a man with a swastika tattoo, say, announces that he doesn’t want a black nurse touching his newborn in the neonatal intensive care unit. (That’s a real case, from a hospital in Flint, Mich.) He’s not obliged to choose a particular hospital. But once he has, a hospital that accommodates his request and assigns employees on that basis is effectively instituting his bias.
Your own medical system should be careful not to make that mistake. There are more complicated cases, to be sure. What about a woman who, as a survivor of sexual assault, asks to be seen by a female gynecologist? Here, surely, it would be reasonable to try to accommodate her, not least because the choice doesn’t reflect disrespect for male doctors, as refusing to be touched by an African-American nurse does reflect disrespect for black medical staff. Not every form of discrimination is invidious. It’s perfectly appropriate for a patient who speaks Spanish to ask for a doctor who does, too. It’s a very different thing for patients to reject a doctor because she also speaks Spanish.
For health care professionals who work in hospital systems, incidents of patient bias can be wounding. That’s why hospitals should, when possible, try to accommodate staff members who don’t want to be assigned to patients who display bias toward them. A doctor’s primary concern is the best care of her patients, and we rightly hold physicians to a higher bar than we do patients. But a health care system has to attend, as well, to the welfare of its staff members.
Aug. 6, 2019
I work for a public medical system, and we have an ethics seminar each month. The last one featured an article by a doctor in one of our hospitals. She discussed patients or their families who insist on having medical providers who are some combination of straight, white, male and/or American-born.
Some seminar participants thought patients should be able to choose such a provider in our system because they can do so in the private care system and because we now encourage them to use the private system if they prefer.
I was shocked that any providers considered it ethical to support patients’ openly making health care decisions based on bias. The point was also made that treatment is often provided in emergency settings where a patient’s life is at stake. Many of our treatment options are aimed at small populations of patients, so there may be only one practitioner available. That practitioner may not be male, straight, white or American-born. Patients cannot receive some types of specialty care outside our system, so they do not have the option of shopping around for all types of medical care. Is it truly ethical for patients to demand that their bigotry dictate who treats them? Name Withheld
Is it ethical for patients to want their bigotry to be accommodated? That’s an easy question: no, because expressing bigotry isn’t ethical. The harder question is whether health care professionals ought to accommodate their bigotry.
Everyone knows that doctors must not discriminate on the basis of gender, sexuality, race, religion or national origin when they select or treat patients: It’s an obligation they accepted when they entered the health care profession. (That doesn’t mean they have to take all comers; they can turn away patients for various other reasons.) But should patients be able to choose clinicians on the basis of such attributes? The answer is: It depends.
In an outpatient setting — in private care, as you note — patients can freely discriminate in choosing whom they want to treat them. That may be unethical as a matter of personal conduct, but we don’t want a system that would try to sift through their motives and correct for invidious ones. We’re in the Zocdoc era — something like Tinder M.D. Patient-consumers, in this context, have the prerogatives enjoyed by suitors to make choices that are biased and boneheaded.
The picture changes when we’re in an institutional setting, one in which patients haven’t chosen their health care practitioner. The picture changes when a man with a swastika tattoo, say, announces that he doesn’t want a black nurse touching his newborn in the neonatal intensive care unit. (That’s a real case, from a hospital in Flint, Mich.) He’s not obliged to choose a particular hospital. But once he has, a hospital that accommodates his request and assigns employees on that basis is effectively instituting his bias.
Your own medical system should be careful not to make that mistake. There are more complicated cases, to be sure. What about a woman who, as a survivor of sexual assault, asks to be seen by a female gynecologist? Here, surely, it would be reasonable to try to accommodate her, not least because the choice doesn’t reflect disrespect for male doctors, as refusing to be touched by an African-American nurse does reflect disrespect for black medical staff. Not every form of discrimination is invidious. It’s perfectly appropriate for a patient who speaks Spanish to ask for a doctor who does, too. It’s a very different thing for patients to reject a doctor because she also speaks Spanish.
For health care professionals who work in hospital systems, incidents of patient bias can be wounding. That’s why hospitals should, when possible, try to accommodate staff members who don’t want to be assigned to patients who display bias toward them. A doctor’s primary concern is the best care of her patients, and we rightly hold physicians to a higher bar than we do patients. But a health care system has to attend, as well, to the welfare of its staff members.
Saturday, August 10, 2019
The Surfer’s Secret to Happiness
They don’t seem to regret all that time they don’t spend actually riding waves.By Ellis Avery
Ms. Avery was a writer. She died in February 2019.
Aug. 10, 2019
In 2013, at the age of 41, I decided to make a career change and become a nurse practitioner. At the time, an advanced case of reactive arthritis often left me unable to walk. The entire time that I was taking prerequisite classes, I was in a mobility scooter, a 35-pound dragonfly of a three-wheeler made by a company called TravelScoot. I also needed a large surgical boot on my foot to help me walk.
I rode that mobility scooter in the sun and through the snow, on the bike path by the Hudson River, from my home in the West Village to the Borough of Manhattan Community College downtown. I rode it through the intestinal maze of the New York City subway system, through tunnels that trapped the heat and cold of the previous day’s weather, up and down elevators that trapped the odor of urine, to New York City College of Technology in Brooklyn. I rode it and rode it and rode it, and wondered if I’d ever walk again.
This isn’t the real me, I wanted to tell the world. This time doesn’t count. When I walk again, that’s when I’ll be real.
Amid the misery, I let myself hope. A physician assistant at my primary-care doctor’s office told me about one of her fellow students, a man with cerebral palsy, who had completed the program and graduated while using a wheelchair. In 2016, I was accepted into a community college nursing program, but then told to come back when I didn’t need a boot, which might mean never.
I continued to ride my scooter and to believe that some school, somewhere, would make a place for me. I didn’t see my future self briskly striding through hospital corridors. I just needed to get through school so that one day I could sit behind a desk at a health center or work in an outpatient clinic. There was plenty of nursing work that could be done just as well in a surgical boot as in a shoe. I could write a prescription, give a vaccine, insert an IUD. I could look a patient in the eye and listen.
In July 2017, I was out of the boot and walking again for the first time in years. My spouse and I were thinking about moving to Australia, so I applied to programs there and was admitted to nursing school at the University of Melbourne. After completing my first semester, I decamped to Sydney for a month. There, I lived in an apartment overlooking Bondi Beach, perhaps the most beloved urban surfing destination in the world.
Day after day, I watched the surfers. I daydreamed about taking a surfing lesson, but my hold on walking felt so recent and unlikely, I didn’t chance it. And in other ways, it already felt like I was surfing. I was surfing on the arthritis medication I had starting taking in spring 2016. I was surfing on the steroid shot I’d gotten in April of 2017. I was surfing on the immuno-modulating probiotics with which I was experimenting. Just as if I were a surfer, any little thing could knock me off my board and back into arthritic misery, back into the boot and scooter I had come to know and loathe.
Watching the surfers, I noticed that the time they spent standing on their boards, riding waves — doing what nonsurfers would call surfing — was minimal compared with the time they spent bobbing around in the water next to the board, generally going nowhere. Even the really good surfers spend far more time off the board than on it.
If you added up the seconds that a good surfer actually spent riding the waves, it would amount to only the smallest fraction of an entire life. Yet surfers are surfers all the time. They are surfers while they are working their crap jobs, daydreaming about surfing. They are surfers when they wake up at 4 in the morning. They are surfers when they walk the board down the hill to Bondi Beach. They are surfers when they drink their predawn espressos. They are surfers when they paddle out on their boards. They are surfers when they wait and wait for the right wave. They are surfers when they wipe out, thrashing around blindly in the waves, praying the board doesn’t crack their skulls. They are surfers when they sit by their trucks with their friends after surfing, silently eating their grain-bowl meals.
And the thing about surfers? They don’t seem to regret all that time they don’t spend standing on boards and riding waves. Not only are they surfers all the time, they are, it seems to me, happy all the time.
Could I do that? Could I be happy even when I didn’t know whether I’d be able to walk the next day, or whether I’d be alive a year from now? Could the time I might spend in the humiliating, tedious boot and scooter somehow count as mine? Instead of waiting to be well so I could be myself again, could I be me while sick, too? Could I declare myself a surfer all the time, and seize that happiness?
I thought back to my time in New York, when I was rising at dawn to take courses and intern in doctors’ offices, and struggling both to get around and to relocate the real me: I had seen a new light in the faces of my fellow students and patients, in our shared endeavor to live. The dark mystery of bodily suffering had offered itself to me as a new way to love New York City, and life, all over again. I had accepted it, with joy. Watching the surfers at Bondi Beach, I vowed to do so again when I returned home in the fall, no matter what. nyt
==
Ellis Avery was the author of two novels, a memoir and a book of poetry. She taught fiction writing at Columbia University and the University of California, Berkeley. She died of cancer in February 2019.
Disability is a series of essays, art and opinion by and about people living with disabilities.
Coming soon in print: “About Us: Essays From The New York Times Disability Series,” edited by Peter Catapano and Rosemarie Garland-Thomson, published by Liveright.
Ms. Avery was a writer. She died in February 2019.
Aug. 10, 2019
In 2013, at the age of 41, I decided to make a career change and become a nurse practitioner. At the time, an advanced case of reactive arthritis often left me unable to walk. The entire time that I was taking prerequisite classes, I was in a mobility scooter, a 35-pound dragonfly of a three-wheeler made by a company called TravelScoot. I also needed a large surgical boot on my foot to help me walk.
I rode that mobility scooter in the sun and through the snow, on the bike path by the Hudson River, from my home in the West Village to the Borough of Manhattan Community College downtown. I rode it through the intestinal maze of the New York City subway system, through tunnels that trapped the heat and cold of the previous day’s weather, up and down elevators that trapped the odor of urine, to New York City College of Technology in Brooklyn. I rode it and rode it and rode it, and wondered if I’d ever walk again.
This isn’t the real me, I wanted to tell the world. This time doesn’t count. When I walk again, that’s when I’ll be real.
Amid the misery, I let myself hope. A physician assistant at my primary-care doctor’s office told me about one of her fellow students, a man with cerebral palsy, who had completed the program and graduated while using a wheelchair. In 2016, I was accepted into a community college nursing program, but then told to come back when I didn’t need a boot, which might mean never.
I continued to ride my scooter and to believe that some school, somewhere, would make a place for me. I didn’t see my future self briskly striding through hospital corridors. I just needed to get through school so that one day I could sit behind a desk at a health center or work in an outpatient clinic. There was plenty of nursing work that could be done just as well in a surgical boot as in a shoe. I could write a prescription, give a vaccine, insert an IUD. I could look a patient in the eye and listen.
In July 2017, I was out of the boot and walking again for the first time in years. My spouse and I were thinking about moving to Australia, so I applied to programs there and was admitted to nursing school at the University of Melbourne. After completing my first semester, I decamped to Sydney for a month. There, I lived in an apartment overlooking Bondi Beach, perhaps the most beloved urban surfing destination in the world.
Day after day, I watched the surfers. I daydreamed about taking a surfing lesson, but my hold on walking felt so recent and unlikely, I didn’t chance it. And in other ways, it already felt like I was surfing. I was surfing on the arthritis medication I had starting taking in spring 2016. I was surfing on the steroid shot I’d gotten in April of 2017. I was surfing on the immuno-modulating probiotics with which I was experimenting. Just as if I were a surfer, any little thing could knock me off my board and back into arthritic misery, back into the boot and scooter I had come to know and loathe.
Watching the surfers, I noticed that the time they spent standing on their boards, riding waves — doing what nonsurfers would call surfing — was minimal compared with the time they spent bobbing around in the water next to the board, generally going nowhere. Even the really good surfers spend far more time off the board than on it.
If you added up the seconds that a good surfer actually spent riding the waves, it would amount to only the smallest fraction of an entire life. Yet surfers are surfers all the time. They are surfers while they are working their crap jobs, daydreaming about surfing. They are surfers when they wake up at 4 in the morning. They are surfers when they walk the board down the hill to Bondi Beach. They are surfers when they drink their predawn espressos. They are surfers when they paddle out on their boards. They are surfers when they wait and wait for the right wave. They are surfers when they wipe out, thrashing around blindly in the waves, praying the board doesn’t crack their skulls. They are surfers when they sit by their trucks with their friends after surfing, silently eating their grain-bowl meals.
And the thing about surfers? They don’t seem to regret all that time they don’t spend standing on boards and riding waves. Not only are they surfers all the time, they are, it seems to me, happy all the time.
Could I do that? Could I be happy even when I didn’t know whether I’d be able to walk the next day, or whether I’d be alive a year from now? Could the time I might spend in the humiliating, tedious boot and scooter somehow count as mine? Instead of waiting to be well so I could be myself again, could I be me while sick, too? Could I declare myself a surfer all the time, and seize that happiness?
I thought back to my time in New York, when I was rising at dawn to take courses and intern in doctors’ offices, and struggling both to get around and to relocate the real me: I had seen a new light in the faces of my fellow students and patients, in our shared endeavor to live. The dark mystery of bodily suffering had offered itself to me as a new way to love New York City, and life, all over again. I had accepted it, with joy. Watching the surfers at Bondi Beach, I vowed to do so again when I returned home in the fall, no matter what. nyt
==
Ellis Avery was the author of two novels, a memoir and a book of poetry. She taught fiction writing at Columbia University and the University of California, Berkeley. She died of cancer in February 2019.
Disability is a series of essays, art and opinion by and about people living with disabilities.
Coming soon in print: “About Us: Essays From The New York Times Disability Series,” edited by Peter Catapano and Rosemarie Garland-Thomson, published by Liveright.
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